Online Patient Forms

At Family Vision Care Associates, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

• You will need AdobeReader® to download and complete the forms.

• Download the required form(s). Print out the form(s) and complete the required information.

• Fax your printed and completed form(s) to our office or bring them with you to your appointment.

New Patient Medical History for Adults / Students

*ALL NEW PATIENTS, please print and complete one of the two Medical History Forms listed below and bring it with you to your appointment.

Print / Complete / Sign - ADULT Medical History Form
Print / Complete / Sign - STUDENT Medical History Form
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Notice of Patient Privacy​​​​​​​

Please READ the NOTICE OF PRIVACY PRACTICE: Read Online | Download/Print
Print / Sign - HIPAA ACKNOWLEDGEMENT
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Other Forms

If you wish to give authorization to someone so that we may discuss your health record and billing pertaining to our office with them, please:

Print / Complete / Sign - HIPAA PRIVACY AUTHORIZATION

If you wish to give us authorization to release your medical record to another doctor or entity, please:
Print / Complete / Sign - RECORD RELEASE

If you wish to give us authorization to exam/treat your minor child without a parent being present, please:
Print / Complete / Sign – PARENTAL CONSENT FOR MINOR
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InfantSEE Program

If you wish to take advantage of a comprehensive vision exam for your infant (The InfantSEE Program), please use the forms (English or Spanish) listed below:

Print / Fill Out InfantSEE Form - English

​​​​​​​Download the Free AdobeReader®